Thursday, October 31, 2013

In the health exchange website
debacle, Washington has moved through denial, anger and finger pointing. Now
we’ve hit the apology stage.

On Wednesday, Kathleen Sebelius, the
secretary of health and human services, called the online marketplace where
people were supposed to be able to compare and buy insurance easily starting
Oct. 1 “a miserably frustrating experience for way too many Americans.”

“You deserve better,” she said at a
House Energy and Commerce Committee hearing. “I apologize.”

And when the terrier from Tennessee,
Republican Rep. Marsha Blackburn, snapped at Sebelius, asking who was
responsible for the mess, Sebelius said, “Hold me accountable for the debacle.
I’m responsible.”

A day earlier, Marilyn Tavenner, administrator
of the Centers for Medicare and Medicaid Services, the agency responsible for
setting up the online marketplaces, also apologized.

“To the millions of Americans who’ve
attempted to use HealthCare.gov to shop and enroll in health care coverage, I
want to apologize to you that the Web site has not worked as well as it
should,” Tavenner said at a House Ways and Means Committee hearing.

President Barack Obama, while stopping
short of an actual apology, has said “nobody is madder than me.” He apparently can’t
brake for pronouns at a time like this.

Seriously, the president must be mad
at himself for letting this fiasco befall his signature legislative achievement.
It’s his legacy at stake. Obama struck a confident note Wednesday in Boston,
insisting that the rollout problems are solvable. A lot is riding on whether the
website is running smoothly Nov. 30, as promised,

In his speech at Faneuil Hall, Obama
sought to clear up confusion about his oft-repeated promise that people could
keep their insurance under the new system. Some people who buy health insurance
on the individual market have received cancellation notices. Obama explained
that a few policies fail to meet consumer protection standards in the health
law, but the people will be eligible for better coverage and possibly for
premium subsidies.

Typically, embattled public figures
follow the old legal advice to doctors facing malpractice claims: “Defend and
deny.” Testifying before Congress, the lawyered-up contractors who engineered
the troubled marketplace avoided showing even a smidgen of remorse.

When a top-level public servant like
Sibelius has the wit to apologize and sound sincere, she conveys the sense that
she gets it, that she knows real people are being hurt by her agency’s ineptitude.

Don’t get me wrong. An apology – many
apologies -- from Washington won’t shorten anyone’s wait on HealthCare.gov or pay
the insurance premium. People want results; they want their government to work.

At the same time, though, people should
realize that Obamacare is a moving political target.

“We did not wage this long and contentious
battle just around a website,” the president says. As rocky as the rollout of
the exchanges has been, the president insists, the Affordable Care Act is
already working to make insurance more readily available and affordable. That,
of course, won’t satisfy the law’s foes.

Obama repeatedly says he’ll work
with anyone who wants to fix the law, but congressional Republicans have no
interest in mending it. If it’s not the website, it’s the canceled policies or the
cost of premiums or something else. The GOP needs to be accountable too.

Where,Republicans, is your
long-promised alternative to the health law? Let us see it – or help fix what’s
broken.

A president saves his apologies for
big moments. Obama reportedly apologized to irate
German Chancellor Angela Merkel after news broke that the United States had been
listening to her phone calls for years. He apologized
Oct. 8, during the government shutdown, for the unfolding fiscal dramas in
Washington.

“To all the American people: I
apologize,” he said, but he couldn’t resist turning the apology into a rebuke,
saying what he needs to do is to break his foes of their bad habits in
negotiations.

Speaking of apologies, I’ve yet to
see tea party Republicans apologize for shutting down the government or sending
the world’s blood pressure sky high with games over raising the debt ceiling.

An apology is not a solution, but it
is a start. It takes guts to say you’re sorry. Who’ll be next?

Thursday, October 24, 2013

President Barack Obama has called in the cavalry to fix the
health exchange rollout fiasco. He has a new tech czar and “some of the best IT
talent in the country” working 24-7 to remove the chewing gum clogging the system.

Too bad Obama can’t fix human nature. People naturally
resent playing by tech rules, even when it’s in their best interest. More on
that in a minute.

Congressional hearings with political overtones are
investigating the botched healthcare.gov website. Contractors who engineered
parts of the contraption blame each other and the federal government. Republicans,
and even a few Democrats, want the head of Health and Human Services Secretary
Kathleen Sebelius. She will face the wrath of the House Energy and Commerce
Committee next week.

The Centers for Medicare and Medicaid Services, which was in
charge of the rollout, went ahead with it despite warnings the system
wouldn’t work.

An insurance executive who was involved in an industry
testing group told The Washington Post that it was clear a month before the
launch that CMS was still working on how the exchanges would handle enrollment,
federal subsidies and the security of consumers’ personal information, such as
income.

That’s a lot. But the last item -- security of personal
information – is most crucial. Millions of people have to give up their birth
dates, Social Security numbers, employment and income information to sign up
for insurance. For people to sign up, they must be confident the government
will keep their sensitive information safe.

And that leads to another issue. As bad as the tech problems
are, the inevitable conflict between man and machine is more troublesome. The insurance
marketplaces – like other online accounts – safeguard personal information by
requiring customers to answer security questions to verify their identity.

Big problem: Many people are flummoxed by online security
questions, The Wall Street Journal reported Wednesday.

Among the questions: What was your high school mascot?
Favorite childhood superhero? Street you lived on in third grade?

“I don’t think they took baby boomers into account when they
invented those questions,” a 58-year-old massage therapist in Texas told the
Journal. Margo Benge said she gave up when she could answer only two of the 12
possible questions – and she needed to answer three. “I barely remember two weeks ago, let alone
childhood,” she said.

And I thought it was just me.

I’ve been resisting online security questions for years. The
problem is the questions sound so reasonable.
In what school did you start first grade?

Anyone would know that, right? Not necessarily. An Air Force
brat, I went to 10 schools before I graduated from high school. I don’t
remember a thing about my school in first grade, except that it was in Germany.

These are details a machine can summon effortlessly. It’s
not as easy for men and women. Life is messy. Our memories overlap, fade and
reconstitute.

Best friend? Don’t make me choose.

Please don’t misunderstand me. I want websites to do whatever
they can to assure privacy. But many web-savvy people say the questions don’t
stop determined hackers anyway. Sarah Palin’s
email was hacked by someone who found out her birth date, ZIP code and the name
of her high school – information that’s widely available on Google and
Facebook.

Here’s a solution. Anyone can arbitrarily decide from today
forward that he or she had Miss Raven as first grade teacher, lived on Lenore Street
in third grade and rode a red bike to Edgar Allen Poe Elementary School. Stumped by security questions? Nevermore.

We humans just have to remember what we made up. We can make
a note. On paper.

Friday, October 18, 2013

President Barack Obama says there were no political winners
in the crisis over the federal government shutdown and debt limit. Most
Americans, regardless of their political persuasion, probably agree.

In Washington, though, every moment has a winner and a
loser. Once the latest financial calamity was averted, most political analysts thought
the president was a winner because he showed some spine, gave up nothing and
kept his signature health care legislation intact.

Conservative Republicans, on the other hand, were losers because
they totally misread the political landscape. Their ill-conceived attempt to
defund Obamacare shut down the government, idled 800,000 workers for 16 days and
hurt the economy – but it yielded only a minor tweak in the health care law. People
who seek subsidies to buy insurance on the exchanges will have to provide
income verification.

Some tea party Republicans cling to the fig leaf notion that
their failed fight over the shutdown actually awakened the nation to the evils
of the Affordable Care Act and support will blossom. Really?

Meanwhile, every Democrat, Republican and independent coast
to coast will pay the cost of the federal shutdown in dollars -- and also in
the incalculable currency of trust.

The pricetag of the latest shutdown hasn’t been released,
but two shutdowns lasting a total of 26 days in 1995-96 cost more than $1.4
billion, the Congressional Research Service reported. That’s $2.1 billion in
current dollars. Most of the money went for back pay for furloughed federal
workers.

The dollar waste is unnecessary and maddening. Trust in our
institutions and government is in short supply.

To squander the people’s trust hurts our political system and is heartbreaking.

“The American people are completely fed up with Washington,”
Obama said Thursday. He’s right, of
course, but it would be nice if he or anyone else could say that Washington has
learned from its misadventure and will work to rebuild the trust it has squandered.
There are only glimmers that some in Congress have learned lessons.

In reaching the deal, members of Congress did what they
should have done months ago. They did their jobs.

The bipartisan agreement reopened
the government and raised the debt limit, allowing the United States to pay the
bills it racked up with two unfunded wars and an unfunded Medicare drug benefit.
It’s merely a reprieve that postpones the fight. In two months or so, we may
face another fiscal crisis.

The plan Obama signed Thursday funds the government through
Jan. 15 and raises the debt ceiling through Feb. 7. On the way there, a
bipartisan, bicameral budget conference is supposed to come up with a long-term
plan on tax and spending policies by Dec. 13. The two Republicans on the
conference committee voted against the bill ending the crisis, and the two Democrats
voted for it. That’s hardly a promising sign.

A glimmer of hope is the 14 centrist senators led by Sen.
Susan Collins, Republican of Maine, who worked together on an agreement that
served as a point of departure for the final deal. The centrists were
disappointed their plan didn’t prevail, but they pledge to keep working
together.

The next round of negotiations could take place in an even more acidic political atmosphere because of
the calendar.

Obama chided Republicans on Thursday, saying, “You don’t
like a particular policy or a particular president, then argue for your
position. Go out there and win an election. Push to change it. But don’t
break…what our predecessors spent over two centuries building.”

Some analysts say the looming 2014 congressional elections
could have a sobering effect on conservatives in the House. In most
congressional districts, though, a Republican incumbent fears a challenger from
his right more than a Democratic one. For most House members, compromise in
Washington can be a terrible career move.

Traditionally, people hate
Congress but like their own member of Congress. That may be changing. About
three in four people said they want to see most members of Congress defeated
next year. And about four in 10 said they’d like to retire their own member of
Congress, a new Pew Research Center survey found.

It’s very possible that we’ll lurch once again from one financial crisis to
the next. That not only would be a shame but would be a drain on what’s left of
trust in government.

This year, Medicare’s open enrollment overlaps with open enrollment for the new insurance marketplaces or exchanges created under the Affordable Care Act, also commonly referred to as Obamacare — but don’t let that throw you. Medicare’s 50 million-plus beneficiaries, most of them seniors, will steer clear of the marketplaces.

Got questions? Here’s what you need to know about Medicare’s open enrollment in the marketplace era.

AARP Members Enjoy Health and Wellness Discounts

Q: I have Medicare. Can I use my online state insurance marketplace to compare and buy a Medicare Advantage, supplement or prescription plan?

A: No, the marketplaces (also known as health exchanges) are not for Medicare beneficiaries. They are mostly for uninsured Americans and do not offer Medicare Advantage, medigap supplemental policies or Part D prescription plans. Medicare is not changing because of the marketplaces. For a medigap or Medicare Advantage plan, consultwww.medicare.gov.

Q: What if I mistakenly sign up for insurance on the marketplace, will my Medicare coverage be automatically canceled?

A: No, if you have Medicare coverage, you won’t qualify for insurance on the marketplace. But if you do sign up for a plan accidentally, cancel the marketplace policy.

Q: But I’m a Medicare beneficiary, and someone contacted me and said I could buy insurance through the marketplace. What’s up?

A: It’s illegal for someone to knowingly sell a Medicare beneficiary a marketplace plan. Watch out for scammers during open enrollment. Do not share your Medicare number or personal information with anyone who says he or she can sell you a plan through the marketplace.

Q: Can I get the premium tax credit that people get when they buy insurance on the marketplaces?

A: If you’re enrolled in Medicare, you’re not eligible for the tax credits that some people qualify for on the marketplaces, but you already get a substantial break on costs. The overall costs of care under Medicare Part B, which pays doctors’ visits, and Part D, the prescription drug benefit, are subsidized 75 percent from federal general revenues. Plus, if you’re a Medicare beneficiary with limited resources and income, you may qualify for low-cost Part D drug coverage under the Extra Help program. Go to www.ssa.gov, call 800-772-1213 or visit your local Social Security office.

Q. I’ve just become eligible for Medicare, but I haven’t signed up yet and haven’t started collecting Social Security. Can I choose coverage on the marketplace instead of Medicare?

A. Yes, but be aware that if you fail to sign up for Medicare during your initial seven-month enrollment period — the three months before the month you turn 65, your birthday month and three months after your 65th birthday — you may have to pay a late enrollment penalty for as long as you have Medicare. Also, if you don’t enroll in Medicare Part B during your initial enrollment period, you can sign up only during what’s called the general enrollment period — Jan. 1 through March 31 — and your coverage won’t begin until July of that year.

More Medicare

Q: I’ll turn 65 next year and will become eligible for Medicare, but I don’t have health insurance now. Can I use the marketplace?

A: Yes, you’re uninsured and can buy a plan on the marketplace now that will be effective Jan. 1. Once you receive Medicare coverage, you should cancel the marketplace plan.

Q: I’m 65, a legal immigrant with a green card and have lived in this country for three years. Can I get Medicare coverage?

A: No, Medicare requires that you have lived in the United States continuously for five years. You may qualify for a health insurance plan on the marketplace, which does not have a residency waiting period.

Q: I’m 65 and Medicare-eligible, but I’m still working and covered by my employer’s health plan. My employer says she may terminate the company plan next year. What are my options?

A: If you didn’t sign up for Medicare Part A or Part B when you were first eligible because you were covered by a group plan based on current employment — yours or a spouse’s — you can sign up for Part A or Part B (or both) anytime you’re still covered by the group plan or during an eight-month period that begins the month after your coverage ends.

Q: I’m eligible for Medicare but didn’t sign up on time, and I haven’t bought insurance through the marketplace. Will I have to pay a fine?

A: Yes, if you’re uninsured and don’t qualify for an exemption to the requirement that everyone carry health insurance in 2014, you will have to pay a penalty. Exemptions include being a member of a federally recognized Indian tribe or having income too low to file a tax return.

Q: I have only Medicare Part A. Do I need to buy more insurance to meet the legal requirement that I have insurance?

A: No, whether you’re in a traditional Medicare or a Medicare Advantage plan, you meet the insurance requirement.

Q: I’m 60 and retired, but I’m too young for Medicare. I get my insurance through my former employer’s retiree health plan. Do I need to get additional coverage on the marketplace to comply with the health law?

AARP Members Enjoy Health and Wellness Discounts

Q: I’m not thrilled with my plan, but there are a lot of choices. Where do I start?

A: Use the Plan Finder tool at www.medicare.gov to compare costs and benefits for each plan available in your area. Details of 2014 plans are available now. If you need personal help, call your State Health Insurance Assistance Program (SHIP). Contact information is at www.shiptalk.org. If you have Medicare Advantage or a Part D prescription drug plan, you should have received a notice of changes for 2014 in the mail. It will tell you whether your premiums, deductibles, copays and benefits will change next year.

Q: Can’t people change their Medicare coverage later than December?

A. Yes, between Jan. 1 and Feb. 14 every year, people with Medicare Advantage plans can leave their plans and switch to traditional Medicare, if they choose. In specific circumstances, such as a move, people can change Medicare coverage anytime.

Q: I’m happy with my current Medicare choices. What do I do during open enrollment?

A: Not a thing. Your current choices will continue next year.

Q: Where can I find more Medicare information?

A: For enrollment information, go to Social Security’s website, www.ssa.gov or call 800-772-1213. For coverage information, go to www.medicare.gov or call 800-MEDICARE (800-633-4227).

Marsha Mercer is a freelance writer in the Washington, D.C., area who covers health policy.

Friday, October 11, 2013

The new health benefit got off to a rocky start. Complaints about
long wait times were flying, and politicians wanted to ditch the law.

“Any time Washington passes a new law, sometimes the
transition period can be interesting,” the president said.

“That,” The New York Times reported dryly, “was something of
an understatement.”

But it wasn’t President Barack Obama, responding last week to
complaints about overwhelmed servers and long waits to access the new online
marketplaces to buy health insurance under the Affordable Care Act.

It was President George W. Bush in March 2006, trying to defuse
anger over a new prescription drug benefit for seniors, known as Medicare Part
D. Democrats and seniors hated it.

“This is lousy legislation,” then-Sen. Tom Daschle, D-S.D., declared
when Bush signed the major new entitlement in December 2003. “We may spend the
rest of our careers repairing the flaws of this bill.”

Sen. Ted Kennedy, D-Mass, thundered at a rally against the drug
benefit: “Who do you trust? The H.M.O.-coddling,
drug-company-loving, Medicare-destroying, Social Security-hating Bush
administration? Or do you trust Democrats, who created Medicare and will fight
with you to defend it – every day of every week of every year?”

The week Bush signed the prescription benefit, only one in
four seniors approved. Republicans and
Democrats were – surprise! -- polarized. Forty-nine percent of Republicans
approved and 52 percent of Democrats disapproved, according to an ABC
News-Washington Post poll.

It’s optional, but nine in 10 seniors choose it. Of these,
90 percent say they’re satisfied with their drug coverage and 60 percent are
very satisfied, according to a survey commissioned by Medicare Today, an
industry group.

So what does all this say about today’s political flashpoint
– Obamacare? It likely is on more solid ground than you might think, despite
House Republicans’ dozens of votes to repeal it and multiple proposals to
defund or delay it.

Only about one in three people has a favorable opinion of
the health law – far from a ringing endorsement. But when you think that only
one in four seniors approved of the drug benefit, one in three is not so
shabby.

Plus, while those who think
Obamacare goes too far make the most fuss, about 7 percent of those who
disapprove of the health law think it didn’t go far enough. There’s still
support for a single-payer system.

Even its most devoted critics concede that once people
actually see the Affordable Care Act in action, they’ll really like it.

In July, Sen. Ted Cruz, R-Tex., told Fox News, “What the
administration desperately wants is to get to January, to get the exchanges in
place…they want people hooked on Obamacare so it can never be unwound. If we’re
going to repeal it, we’ve got to do so now or it will remain with us forever.”

Cruz persuaded his House colleagues to shut down the federal
government in the erroneous belief that Obama would cave on Obamacare. Republicans
succeeded in shutting down the government, but funding was already in place for
the rollout of Obamacare. Open enrollment began as scheduled Oct. 1.

Republicans have backed off repealing and defunding
Obamacare, although they’d still like to delay it.

Obama insists that one day his signature health law will be
as beloved as the Medicare drug benefit. As even Cruz indicated, it’s hard to
see how Congress can take back health insurance after millions of Americans with
pre-existing conditions get coverage starting Jan. 1.

Ironically, the government shutdown Cruz and others
orchestrated has given the exchanges breathing room. The shutdown is more
newsworthy than computer problems plaguing the rollout.

The glitches don’t get the media scrutiny they would if the
marketplaces were the big news story in town.

The Obama administration talks
about the millions who have gone on the marketplaces, but it has not said how
many people have been able to close the deal and buy insurance so far. Open
enrollment continues through March 31.

As another president once said, “Any time Washington passes
a new law, sometimes the transition period can be interesting.”

Thursday, October 3, 2013

A few hours before the federal government pointlessly shut down
for lack of a budget, President Barack Obama called House Speaker John Boehner.

“I’m not going to negotiate,” the president said Monday
night, according to Boehner’s account of the conversation. On the House floor, Boehner
even regaled his pals with a poor imitation of the president’s “I’m not going
to negotiate.”

As bad as the shutdown is, the real crisis could come when
the United States reaches its limit for borrowing money Oct. 17 and faces a
default on some of its debts. Republicans
are insisting on spending cuts or entitlement reform equal to the amount of the
increase in borrowing authority. The White House feared that if it started
negotiating now over the budget, it would be weakened in the coming fight over
the debt ceiling.

For his part, Boehner pledged to Republicans last January
that he would not negotiate one-on-one with Obama ever again. Boehner felt heat
from tea party members, who see compromise as caving, pure and simple. Plus, he felt the White House mistreated him
after he attempted to reach a grand bargain on deficit reduction in 2011 and
2012.

So here we are. The country’s most powerful Democrat and
Republican refused on principle to negotiate, the federal government ground to
a halt for the first time in 17 years, and the worst is yet to come.

Whether you believe Obama or Boehner is right, something is
very wrong when both parties dig in their heels and lead the country into a costly,
stressful, avoidable crisis. We’re better than that. It’s good that the
president finally invited congressional leaders to the White House to talk, but
it should have happened sooner.

Boehner has acquiesced when conservative House Republicans’ claimed
compromise by passing bills that everybody knew were dead on arrival in the
Democratic Senate. That’s brinksmanship, not compromise.

Obama likes to say that “one faction of one party in one
house of Congress in one branch of government” can’t shut the government down.
Except that it has. Now what?

A recent poll indicated that most people prefer a candidate
who “stands up for what he or she believes” over one who “compromises to get
things done.” But that’s a false, either-or choice. We should have both: principled
leaders compromise for the greater good.

New Jersey Gov. Chris Christie is running a new re-election
campaign ad around the novel notion that compromise isn’t a bad thing.

“See, I think as long as you stick to your principles,
compromise isn’t a dirty word,” Republican Christie says in the ad. He insists
that his every accomplishment as governor has been the result of
bipartisanship.

New Jersey has a strong Democratic base, which requires bipartisanship.
In the U.S. House, though, because of the way districts are drawn, lawmakers
need to appeal only to like-minded constituents. There’s little, if any, upside
to cooperation.

With neither side inclined to budge, we’re stuck. But what
would happen if Obama and Boehner called in a true negotiator to break the
impasse?

They could agree to listen to someone like Kenneth Feinberg,
who has been the go-to mediator of compensation for victims of almost every
major disaster in recent American history. Feinberg negotiated settlements for
the victims of 9/11, the Virginia Tech shooting, the BP oil spill in the Gulf
of Mexico, and the shooting victims in Aurora, Colo., and Newtown, Conn. He most recently has been negotiating
payments for victims of the Boston Marathon bombing.

He got his start in this
difficult work in 1984 in a case involving Vietnam veterans who suffered
exposure to Agent Orange.

For anyone who’s sick of business as usual in Washington --
and who isn’t? – it’s intriguing to consider what could happen if someone who
cares about fairness, not political gain, was in charge.

As the shutdown began on Tuesday, World War II veterans came
to visit their memorial in Washington only to find the memorial closed. Around
the country, everyone -- Democrats and Republicans alike -- cheered upon hearing that the old soldiers simply
walked or rolled their wheelchairs around the barriers.

What we need now is someone who will remove the barriers
between Congress and the president, and get us rolling on the path to a
functional government. Calling Ken Feinberg.